- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,762.47 / $12,022.64
| Professional | | $6,309.57 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,848.93
| Facility | | $15,135.61 | $15,135.61 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $17,782.79
| Professional | | $8,511.38 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $10,232.93
| Professional | | $7,943.28 | $7,943.28 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,332.54 / $9,332.54
| Facility | | $6,165.95 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $9,332.54
| Professional | | $6,918.31 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,471.29 / $15,135.61 / $20,892.96
| Professional | | $10,471.29 | $15,135.61 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,772.37 / $14,791.08
| Professional | | $7,943.28 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,715.19 / $19,054.61
| Facility | | $6,165.95 | $10,715.19 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,511.38 / $9,772.37
| Professional | | $8,128.31 | $8,511.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,481.54 / $19,952.62
| Facility | | $8,128.31 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,481.54 / $19,952.62
| Professional | | $8,128.31 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,715.19 / $19,498.45
| Facility | | $5,370.32 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,413.10 / $10,964.78
| Professional | | $6,760.83 | $7,413.10 | $10,964.78 |